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HomeAnswersEndocrinologyadrenal insufficiencyA patient has fatigue, weight loss, and headaches. Why?

How to confirm if a patient has adrenal insufficiency?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At April 5, 2022
Reviewed AtOctober 6, 2023

Patient's Query

Hello doctor,

A patient suffers from the following symptoms;

1. Worsening fatigue, muscle weakness, malaise, for the past three months, though it was present to a smaller extent over several years.

2. Unintentional 30 lbs weight loss over one year.

3. Headaches over the past month.

4.Tremors, eye flashes, insomnia, irritable bowel syndrome, general poor appetite are present for at least one year.

5. Anxiety, depression.

6. Intermittent orthostatic hypotension and generalized hypotension have been present for the past six months.

7. Muscle twitches, mildly blurry vision are also presented since summer.

Alcohol abuse in recovery for 15 months. Unremarkable head MRI, head CT, regular basic CBC report, normal echo, normal ophthalmological exam. Cortisol of 11.4 mcg/dL and ACTH of 17 pg/mL in the morning.

Currently under

1. Trazodone 50 mg at bedtime.

2. Fluoxetine 30 mg once daily.

3. Vitamin D 5000 units daily.

4. Women's daily multivitamin (none of the above-mentioned medicines are prescribed for the current complaints)

Would you consider secondary or tertiary adrenal insufficiency a likely culprit, or would you recommend seeking a diagnosis elsewhere?

Kindly help.

Hi,

Welcome to icliniq.com.

I read your query, and I can understand your concern. The symptoms do have some elements suggestive of adrenal insufficiency. Fatigue, weight loss, poor appetite, orthostatic hypotension are suggestive whereas anxiety, depression, muscle twitches, eye flashes, insomnia, irritable bowel are not. Thyroid tests should be done. Is any other substance abuse present other than alcohol? Or any chronic use of prescription of opiates or benzodiazepines? Morning Cortisol of 11.4 mcg/dL does not rule out adrenal Insufficiency. Low ACTH (adrenocorticotropic hormone) makes it complex. For now, start with a Cosyntropin stimulation test. Then, if needed Metyrapone test or insulin tolerance test can be done.

Patient's Query

Hi doctor,

Thank you for the reply.

Yes, it is somewhat expected that this will be a potential multiple diagnosis. Anxiety, depression, and IBS, to clarify, are long-standing issues. Muscle twitches etc. were only recently noted as being abnormal and it had been assumed to be a normal "human" experience. Thyroid values were normal. No history of other substance abuse. No prescription drug abuse or use of steroids of any kind.

Thank you.

Hello,

Welcome back to icliniq.com.

Fine, I can understand your concern.

While arranging for an adrenocorticotropic hormone (ACTH) stimulation test, if you have not seen anybody other than your PCP (primary care physician), start with a neurologist. Other endocrine causes such as pheochromocytoma or hypoglycemic disorder are extremely unlikely. Maybe check for micronutrient deficiencies like Thiamine, Folic acid, Vitamin B12, Zinc. Also, check for heavy metal poisonings like lead and mercury. That is all my information for now.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Thiyagarajan. T
Dr. Thiyagarajan. T

Diabetology

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